Euthanasia Flashcards
How can we make the worst day in a pet parent’s life, as good as it can be?
- minimize stress/anxiety
- minimize pain/discomfort
- minimize adverse signs
- Smooth and timely passing
What does natural death look like?
Agonal breaths > opisthotonos > cardiac arrest > urination and defecation > muscle twitching > leaking fluid > minutes to hours
Why do people choose euthanasia vs natural passing?
what tool can can clients use to help them decide when its time to euthanize?
Euthanasia is chosen, when QOL declines, when it has declined significantly when a pet is suffering or to prevent suffering.
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Quality of Life Scales plays a significant part in client decision making
is it better if clients stay with the pet as it is euthanized?
When people have special relationships with their pets, they don’t want to drop the pet off at the clinic and walk away. When I graduated, we charged clients an extra $50 to stay and we encouraged them not to as it was very emotional when owners were present. Now, I encourage clients to remain with their pets, even if they feel it would be too difficult to be present.
good places for euthanasia
I know not everyone wants them to pass in their home, but for those that do, no one has said they wished they went to the clinic to do this.
The euthanasia can take place in the pet’s bed, owner’s bed, backyard…
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In home, backyard, park, beach or vet clinic
The way I think about it, there are 4 parts to the Euthanasia appt, which are roughly 15 min each:
1 - Introduction
2 - Sedation
3 - Euthanasia
4 - Memorialization and bundling
what to do in the introduction of a euthanasia appointment
Introduce yourself
Acknowledge Pet
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Discuss the pet’s condition through observation and (brief) examination
how has she been doing at home these past few days?
Is this a significant change from last week / last month ?
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Eating & Drinking? Vomiting or Diarrhea?
Mobility: Going for walks as usual?
Still social with other pets or withdrawn?
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when was the most recent visit to your regular veterinarian?
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Euthanasia Consent form
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Explain Euthanasia Procedure. Reaffirm their decision to euthanize. Affirm your agreement with this decision. You are a partner in this. This relieves tremendous guilt on their end.
Have you been present for a euthanasia before?
what is included in the euthanasia consent form
Must include: pet and owner information, confirmation the pet hasn’t bitten anyone in the past 10 days, aftercare. I include drug amounts. Any other relevant information regarding owner’s wishes. WRITE IT DOWN. If payment is to be collected, can do it now but ideally this should be done by phone before the appointment, or even better, a few days after the appt.
sedation step of euthanasia procedure
- what do we do?
- what drugs?
- where to inject?
- how fast does it work?
I explain our protocol may be a little different from what clients have experienced previously. Many clients haven’t been present for previous euthanasias or the first part of catheterizing was done in the back room.
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The euthanasia we practice is a two part process, with sedation being the first part.
In dogs, actually a 3 part process, starting with Dormosedan. A small to large pea sized amount on a gloved finger rubbed onto the dog’s gums causes sedation in 10 minutes. Minimizes or eliminates the sting of the sedative injection, which is my next step.
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DORMOSEDAN GEL (detomidine hydrochloride) GEL is an oromucosal sedative containing detomidine hydrochloride. Alpha 2 agonist. Off label use. ACEPROMAZINE GEL (not routinely used)
Once the pet is sleeping from the dormosedan, or in cats, when the owner is holding them, the injectable sedative is given into the sublumbar muscles.
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SEDATE:
The sedative drugs are a combination of very strong sedatives and pain relievers, and would actually be considered anesthesia because of the ketamine.
For dogs, I use a combination of:
Ketamine
Midazolam
Acepromazine
Butorphanol
Xylazine - is not given to cats.
-it is given as an injection using a very small needle into the sublumbar muscles.
If the pet is aggressive, we require a telemedicine appt to establish VCPR and be able to dispense medications.
NOTE: dogs > 50 lbs., very painful, stoic & working dogs usually take longer for the sedation to take effect. Will need more sedation than expected.
If a dog is going to vomit or defecate, this also prolongs the time to reach adequate sedation. Otherwise, the pet starts to get sleepy in just a few minutes. I check toe pinch to assess if ready to proceed. Sedation begins within 1-2 min but I usually wait around 10 min. I have only had 2 dogs have seizures after sedation was given (in over 10 years).
why do we sedate for euthanasia?
should we always do it?
- Relax pet, no stress/no more pain
- Easier to place catheter - don’t break the HAB by taking the pet away from owner prior to passing (I do housecalls alone without a tech and do catheterization alone)
- Smoother transition for pet from awake>sedation>anesthetic>death Reduces chances of spasms/twitches/agonal breathing
- Secondary sedation for owners
YES…. SEDATE!
Euthanasia step of procedure:
- how do we knkow when to proceed?
- what do we tell clients?
- what drug to use? how does it work?
Once you have determined the pet is ready, by toe pinch and observation, let the owners know and ask if ok to proceed.
Tell the client’s that you will now administer the euthanasia drug. I let them know how long it will likely take for the pet to pass. Times differ depending on the route of administration of the drug.
Overdose of Pentobarbital which stops the activity of the brain and nervous system. Brain function will stop, followed by the breathing and lastly, the heart.
Always ensure that extra drug is readily accessible, in case you need more.
routes of admin for penobarbital, options
IV catheters, butterfly or regular needle and syringe all possible to use.
-Intravenous - veins saphenous, cephalic, dorsal pedal
-Intrarenal for cats and small dogs.
6 mls into the cortex. Up or down side usable.
Practice palpating kidneys on sedated/anesthetized cats to improve your skills.
They usually pass as fast as placing IV
-Intrahepatic
-Intracardiac
warnings for owners during euthanasia
- things they may not like to see
- Twitching - face and muzzle within the next 10 min. Normal
- Agonal breathing - looks awful. Happens more when close to natural death. It is a brainstem reflex.
- Urination due to relaxation of urethral sphincter ***
- Defecation - rarer
- Eyelids not closing ***
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I usually just inform owners about 3 and 5. The pet’s muscles are not working and everything relaxes.
Death is a phase, not an exact moment
how do we confirm death?
Listen for the heart beat to confirm that it has stopped. If there is no heartbeat inform the owner by telling them that “she’s gone” / “she’s passed”. If you can hear a heartbeat explain to the owner that you are going to wait a couple more minutes and check again.
Always stay calm in front of the owners.
memorial and bundling
- options
- importance
- how to avoid complaints
- Paw print and fur clippings can be done in front of the owner after the pet has passed.
- After the passing of a pet, whether by natural causes, unnatural causes or humane euthanasia, any links to the deceased pet play a crucial role in the healing of the pet’s family.
-Clay paw prints - simple ones can be done in the home or can be done at crematorium/aquamation centre.
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Making a paw print in front of an owner is a special way to hold on to a part of the pet. Some owners have a particular paw they want to have a clay print of, others want all 4. Crematoriums offer this service as well but the print is slightly more stylized and I have had owners comment that it didn’t look like their pet’s paw. Doing it in front of the owner prevents this occurrence. They even like the fur and dirt embedded in the prints we make. Painting the clay print a simple colour or even colour matching the fur can be done.
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-Clay Nose prints
-Ink prints of nose or paw - owners like this if they are planning on tatooing the pet’s paw print on themselves.
-Fur clipping - owners have told me they like to smell and touch the fur. Pet parents don’t want to forget. They don’t want to forget how a pet looks, feels, and smells.
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Honoring the death, honours the pet’s life.
